Raynaud's phenomenon: description of capillaroscopic patterns and their clinical and immunological relationship

Abstract

Raynaud’s phenomenon (RF) is an exaggerated vasospastic response to cold, physical or emotional stimuli, of clinical diagnosis, being able to be primary or secondary. Capillaroscopy and immunology help to determine his etiology.

The aim was to describe the capillaroscopic characteristics and association to clinical and immunological manifestations in a cohort of patients with RF.

We conducted an observational, descriptive, retrospective study, reviewing the capillaroscopies performed between June/2014 to June 2018, with an ARCANO Optical Capillaroscope. Demographic data, comorbidities, toxicities, date of onset of RF, macroscopic lesions (digital ulcers, nail lesions, telangiectasias, puffy fingers and sclerodactyly), clinical manifestations (interstitial lung disease, pulmonary hypertension), sicca syndrome, muscle weakness, cardiac involvement, gastroesophageal reflux, arthritis) and immunological laboratory (antinuclear antibodies -ANA-, anticentromere, anti-Scl 70, anti – RO, anti – LA, anti RNP, anti DNA, Anticardiolipins, anti – Sm, anti Jo1 and anti Mi2). The diagnosis was classified as: Scleroderma (ES), other collagenopathies, undifferentiated collagenopathy (defined by negative autoimmune serology, compatible clinical and abnormal capillaroscopy) and primary RF. Number of capillaries (NofC), avascular areas, dystrophies, ectasias, megacapillaries, dilations and microhemorrhages were evaluated by capillaroscopy. The capillaroscopic patterns were classified as early (the combination of few enlarged/giant capillaries, few capillary microhemorrhages, a relatively well-preserved capillary distribution and no evident loss of capillaries), active (frequent giant capillaries, frequent capillary microhemorrhages, moderate loss of capillaries, mild disorganization of the capillary architecture and absent or mild ramified capillaries) and late (irregular enlargement of the capillaries, few or absent giant capillaries and microhemorrhages, severe loss of capillaries with large avascular areas, disorganization of the normal capillary array and ramified/bushy capillaries). Quantitative variables were expressed in median and interquartile range and qualitative variables in proportion and percentage. They were compared with Student and Fischer test, respectively.

A total of 138 capillaroscopies were done to 127 patients. We analyzed the clinical records of 70 (57,9%); 10 (7,2%) has a second capillaroscopy to follow up. SD patterns: 29 active, 17 early, 20 normal, no significant differences in clinical manifestations or immunology between groups, except ANA, its was more frequent in active pattern (p = 0.04). In follow up capillaroscopies, 3 patients have different pattern; one with LES was reclassified as Scleroderma with the same capillaroscopy.

The more frequent pattern was active and its was associated with ANA, while there was not relationship between clinical manifestations with different capillaroscopic patterns.